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US health insurance risk pool in states

US health insurance risk pool in states

A 2007 report by the united health foundation puts the percentage of uninsured people in the USA at 15.9%. The state risk pools aim at providing health insurance to a section of these uninsured masses. It provides health insurance to those people who can pay for it but are deprived of health cover because they have certain pre existing medical problems.

According to a recent report, about 60% of the people in the US get their health insurance through their employers. A separate 27% get it through different government sponsored programmes under Medicaid, children’s healthcare programmes, Native American healthcare etc.

The remaining people are mostly self employed or working for small employers not providing health insurance. These people can purchase insurance directly from private carriers if they are otherwise healthy. But if the person has a pre existing medical condition or other high risk factors, he may find it difficult to purchase insurance from a private carrier. This is where high risk state sponsored programmes come in. let us understand why this is so.

Health insurance companies offer insurances in order to gain profits. They would not welcome the idea of selling insurance to clients who may make claims. Their profit lies in a positive difference between premiums paid and expenses made. When the company sells business to a company, it is required by law to cover all members, both sick and healthy. The companies ensure profitability by fixing a premium rate which will result in the number of healthy employees exceeding the sick ones. It is as if the company s ‘betting‘on you not falling sick. This is how it ensures that the amounts paid by healthy members more than covers the claims put forward by unhealthy ones.

This is the area that state risk pools deal with. It was first started in Minnesota. It basically creates a group of people whom the companies don't want to offer insurance to. It then provides state insurance to this group but at a cost that is higher than a plan would have cost under normal circumstances. At present, thirty four states have these plans and they provide cover to around 183000 people.

These state pools differ greatly in the benefits they offer, eligibilities and funding. At the core, these are groups that provide nonprofit associations created by the state that do not need tax dollars for purposes of operation. They are a temporary solution for people denied covers because of a medical condition. They also facilitate individuals in filing up gaps in their insurance. The following are the names of state pools and their contact numbers.

  • Alabama Health Insurance Plan: 1 800 513 1384 / 334 353 8924
  • Alaska Comprehensive Health Insurance Association: 1 888 290 0616
  • Arkansas Comprehensive Health Insurance Plan: 1 800 285 6477
  • California Major Risk Medical Insurance Program: 1 800 289 6574 / 916 324 4695
  • CoverColorado: 303 863 1960 / 1 866 787 9129 (Monday to Friday - 8am to 5pm)
  • Connecticut Health Reinsurance Association: 1 800 842 0004 (Monday to Friday - 9am to 4pm EST)
  • Florida Comprehensive Health Association: 850 309 1200 (closed since '91)
  • Idaho Individual High Risk Reinsurance Pool: 1 800 721 3272
  • Illinois Comprehensive Health Insurance Plan: 1 866 851 2751 / 217 782 6333
  • Indiana Comprehensive Health Association: 1 800 552 7921 / 317 614 2000
  • Health Insurance Plan of Iowa: 1 877 793 6880 (Monday to Friday - 8am to 5pm CST)
  • Kansas Health Insurance Association: 1 800 362 9290 (Monday to Friday - 8am to 5pm)
  • Kentucky Access: 1 866 405 6145
  • Louisiana Health Plan: 1 800 736 0947 / 504 926 6245
  • Maryland Health Insurance Plan: 1 888 444 9016 (Monday to Friday - 8am to 5pm)
  • Minnesota Comprehensive Health Association: 1 866 894 8053
  • Mississippi Comprehensive Health Insurance Risk Pool: 1 888 820 9400
  • Montana Comprehensive Health Association: 1 800 447 7828
  • Nebraska Comprehensive Health Insurance Pool: 402 343 3574 / 1 877 348 4304 (Monday to Friday - 8am to 4:30pm)
  • New Hampshire Health Plan: 1 877 888 6447
  • New Mexico Medical Insurance Pool: 505 622 4711
  • Comprehensive Health Association of North Dakota: 1 800 737 0016 / 701 277 2271
  • Oklahoma Health Insurance High Risk Pool: 1 800 255 6065 / 913 362 0040
  • Oregon Medical Insurance Pool: 1 800 848 7280 / 503 225 6620 (Monday to Friday - 8am to 5pm)
  • South Carolina Health Insurance Pool: 1 800 868 2500 / 1 803 788 0500 (ext. 42757)
  • South Dakota Risk Pool: 605 773 3148
  • Tennessee's Tenncare Program: 1 888 486 9355
  • Texas Health Insurance Risk Pool: 1 888 398 3927
  • Utah Comprehensive Health Insurance Pool: 1 800 705 9173 / 801 442 6660
  • Washington State Health Insurance Pool: 1 800 877 5187
  • West Virginia Health Insurance Plan: 1 866 445 8491
  • Wisconsin Health Insurance Risk Sharing Plan: 1 800 828 4777
  • Wyoming Health Insurance Pool: 307 634 1393

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